MyMedi-AI

L2425 — Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint

HCPCS Level II L-code · short descriptor: “Knee disc/dial lock/adj flex”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
MUE unit limit
4
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L2425 Medicare fee schedule (October 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $171.93 to $189.18 depending on state and rural status.

Former-CBA payment limits: ceiling $209.83 · floor $157.37

StateNon-ruralRural
AK$171.93—
AL$177.12—
AR$177.11—
AZ$171.93—
CA$171.93—
CO$178.12—
CT$171.93—
DC$171.93—
DE$171.93—
FL$177.12—
GA$177.12—
HI$171.93—
IA$175.28—
ID$171.93—
IL$176.17—
IN$176.17—
KS$175.28—
KY$177.12—
LA$177.11—
MA$171.93—
MD$171.93—
ME$171.93—
MI$176.17—
MN$176.17—
MO$175.28—
MS$177.12—
MT$178.12—
NC$177.12—
ND$178.12—
NE$175.28—
NH$171.93—
NJ$171.93—
NM$177.11—
NV$171.93—
NY$171.93—
OH$176.17—
OK$177.11—
OR$171.93—
PA$171.93—
PR$189.18—
RI$171.93—
SC$177.12—
SD$178.12—
TN$177.12—
TX$177.11—
UT$178.12—
VA$171.93—
VI$189.18—
VT$171.93—
WA$171.93—
WI$176.17—
WV$171.93—
WY$178.12—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps L2425 at 4 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.

Common denial codes to watch

Related L-codes

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